PMID- 34379106
OWN - NLM
STAT- MEDLINE
DCOM- 20220124
LR  - 20220812
IS  - 2168-6262 (Electronic)
IS  - 2168-6254 (Print)
IS  - 2168-6254 (Linking)
VI  - 156
IP  - 11
DP  - 2021 Nov 1
TI  - Evaluation of Early vs Standard Liver Transplant for Alcohol-Associated Liver 
      Disease.
PG  - 1026-1034
LID - 10.1001/jamasurg.2021.3748 [doi]
AB  - IMPORTANCE: Traditionally, liver transplant (LT) for alcohol-associated liver 
      disease (ALD) requires 6 months of abstinence. Although early LT before 6 months 
      of abstinence has been associated with decreased mortality for decompensated ALD, 
      this practice remains controversial and concentrated at a few centers. OBJECTIVE: 
      To define patient, allograft, and relapse-free survival in early LT for ALD, and 
      to investigate the association between these survival outcomes and early vs 
      standard LT. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed all 
      patients with ALD who underwent their first LT at a single academic referral 
      center between October 1, 2012, and November 13, 2020. Patients with known 
      pretransplant hepatocellular carcinoma, hepatitis B or C, or an alternative cause 
      of liver failure were excluded. Follow-up period was defined as the time from LT 
      to the most recent encounter with a transplant center or death. EXPOSURES: The 
      exposure of interest was early LT, which was defined as less than 180 days of 
      pre-LT abstinence. Standard LT was defined as 180 days or more of pre-LT 
      abstinence. Patients were separated into early LT and standard LT by time from 
      abstinence to LT. MAIN OUTCOMES AND MEASURES: The outcomes were patient, 
      allograft, relapse-free, and hazardous relapse-free survival for patients who 
      underwent early LT or standard LT. These groups were compared by log-rank testing 
      of Kaplan-Meier estimates. Hazardous relapse was defined as binge, at-risk, or 
      frequent drinking. Abstinence was reassessed at the most recent follow-up visit 
      for all patients. RESULTS: Of the 163 patients with ALD included in this study, 
      88 (54%) underwent early LT and 75 (46%) underwent standard LT. This cohort had a 
      mean (SD) age at transplant of 52 (10) years and was predominantly composed of 
      108 male patients (66%). Recipients of early LT vs standard LT were younger 
      (median [interquartile range (IQR)] age, 49.7 [39.0-54.2] years vs 54.6 
      [48.7-60.0] years; P < .001) and had a higher median (IQR) Model for End-stage 
      Liver Disease score at listing (35.0 [29.0-39.0] vs 20.0 [13.0-26.0]; P < .001). 
      Both recipients of early LT and standard LT had similar 1-year patient survival 
      (94.1% [95% CI, 86.3%-97.5%] vs 95.9% [95% CI, 87.8%-98.7%]; P = .60), allograft 
      survival (92.7% [95% CI, 84.4%-96.7%] vs 90.5% [95% CI, 81.0%-95.3%]; P = .42), 
      relapse-free survival (80.4% [95% CI, 69.1%-88.0%] vs 83.5% [95% CI, 
      72.2%-90.6%]; P = .41), and hazardous relapse-free survival (85.8% [95% CI, 
      75.1%-92.2%] vs 89.6% [95% CI, 79.5%-94.9%]; P = .41). CONCLUSIONS AND RELEVANCE: 
      Adherence to the 6-month rule was not associated with superior patient survival, 
      allograft survival, or relapse-free survival among selected patients. This 
      finding suggests that patients with ALD should not be categorically excluded from 
      LT solely on the basis of 6 months of abstinence, but rather alternative 
      selection criteria should be identified that are based on need and posttransplant 
      outcomes.
FAU - Herrick-Reynolds, Kayleigh M
AU  - Herrick-Reynolds KM
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
AD  - Department of Surgery, Walter Reed National Military Medical Center, Bethesda, 
      Maryland.
FAU - Punchhi, Gopika
AU  - Punchhi G
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Greenberg, Ross S
AU  - Greenberg RS
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Strauss, Alexandra T
AU  - Strauss AT
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins University School of 
      Medicine, Baltimore, Maryland.
FAU - Boyarsky, Brian J
AU  - Boyarsky BJ
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Weeks-Groh, Sharon R
AU  - Weeks-Groh SR
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Krach, Michelle R
AU  - Krach MR
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Anders, Robert A
AU  - Anders RA
AD  - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Gurakar, Ahmet
AU  - Gurakar A
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins University School of 
      Medicine, Baltimore, Maryland.
FAU - Chen, Po-Hung
AU  - Chen PH
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins University School of 
      Medicine, Baltimore, Maryland.
FAU - Segev, Dorry L
AU  - Segev DL
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
AD  - Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, 
      Maryland.
FAU - King, Elizabeth A
AU  - King EA
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Philosophe, Benjamin
AU  - Philosophe B
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Ottman, Shane E
AU  - Ottman SE
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Wesson, Russell N
AU  - Wesson RN
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Garonzik-Wang, Jacqueline M
AU  - Garonzik-Wang JM
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
FAU - Cameron, Andrew M
AU  - Cameron AM
AD  - Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, 
      Maryland.
LA  - eng
GR  - K23 AA028297/AA/NIAAA NIH HHS/United States
GR  - P50 AA027054/AA/NIAAA NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - JAMA Surg
JT  - JAMA surgery
JID - 101589553
SB  - IM
CIN - JAMA Surg. 2021 Nov 1;156(11):1034-1035. PMID: 34379089
CIN - JAMA Surg. 2022 Apr 1;157(4):360-361. PMID: 34985510
CIN - JAMA Surg. 2022 Apr 1;157(4):360. PMID: 34985523
MH  - Adult
MH  - Alcohol Abstinence
MH  - Cohort Studies
MH  - Disease-Free Survival
MH  - Female
MH  - Graft Survival
MH  - Humans
MH  - Liver Diseases, Alcoholic/*mortality/*surgery
MH  - *Liver Transplantation
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Survival Rate
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC8358815
COIS- Conflict of Interest Disclosures: Dr Chen reported receiving grants from the 
      National Institute on Alcohol Abuse and Alcoholism during the conduct of the 
      study and grants from Gilead Sciences Research Scholars Programs outside the 
      submitted work. No other disclosures were reported.
EDAT- 2021/08/12 06:00
MHDA- 2022/01/27 06:00
PMCR- 2022/08/11
CRDT- 2021/08/11 12:19
PHST- 2021/08/12 06:00 [pubmed]
PHST- 2022/01/27 06:00 [medline]
PHST- 2021/08/11 12:19 [entrez]
PHST- 2022/08/11 00:00 [pmc-release]
AID - 2782929 [pii]
AID - soi210058 [pii]
AID - 10.1001/jamasurg.2021.3748 [doi]
PST - ppublish
SO  - JAMA Surg. 2021 Nov 1;156(11):1026-1034. doi: 10.1001/jamasurg.2021.3748.